Debra Grabow, Hazen
Are you ready to die?
I have been a critical care nurse for nearly 20 years. I have seen much death. I have witnessed horrible death and beautiful death. In my experience, death is easier to handle and grieve for if we are prepared and family/significant others in our life are aware of the dying person's wishes.
Advance care planning is the process of coming to understand, reflect on, discuss and plan for a time when you cannot make your own medical decisions.
It is a process aimed at extending the rights of competent adults to guide their medical care through periods of decisional incapacity. The process, when accomplished comprehensively, involves three steps: (1) thinking through one's values and preferences, (2) talking about one's values and preferences with others, and (3) documenting them. The ideal situation is to establish these wishes when you are not acutely ill.
Advance Care Planning can and should include discussions and document plans that address the "ifs" and ambiguities of end-of-life.
Topics to discuss are numerous and should include the role of the family, their interests, well-being, and their authority to revise advance care planning documents. Discussion should take place about CPR (cardiopulmonary resuscitation), DNR ("do not resuscitate") and respirators.
The treatment plans within advance care planning can include pain management, hydration issues, artificial nutrition, blood transfusions, organ and tissue donation and medical device donation.
Advance Care Planning can even include funeral and memorial services as well as final disposition plans whether cremation or burial.
"Five Wishes" is a document that helps you express how you want to be treated if you are seriously ill and unable to speak for yourself. It deals with all of a person's needs: medical, personal, emotional, and spiritual. The document, when fully completed, designates a healthcare power of attorney, a living will, and a desired comfort level and includes two sections addressing personal and emotional preferences as death approaches and passes.
Research conducted by the Agency for Healthcare Research and Quality indicates that most patients have not participated in advance care planning, yet many are willing to discuss end-of-life care. They also found that less than 50 percent of severely or terminally ill patients studied had an advance directive in their medical record, and only 12 percent of patients with an advance directive had received input from their physician in its development.
In this advent of the Affordable Care Act, this planning is encouraged amongst you and your primary care provider. Fill out the "five wishes" form and share it with your PCP.
The misconception is that the Affordable Care Act will allow the physician to make the decision or perhaps hasten death. In truth, it allows the physician the opportunity to discuss advance care planning and bill the insurance company accordingly. It will become a part of the treatment plan.
I do believe that very few people are truly ready to embrace death. I have seen many unnecessary and life-prolonging tests done to patients that only delayed the inevitable. I have watched grieving families lament as I "unplugged" their loved ones from the ventilator under the direction of a physician. In my experience, the greatest acceptance of their choice to discontinue life support has been the dying patient's acceptance of their fate. The great question here is "Who decides?"
Please share with your family/significant others your wishes. Ask them to honor your decision and love you enough to let you go.